By Eric Fishman, MD
President
EMRConsultant.com
info@emrconsultant.com

There are a number of acronyms concerning the industry. Some are confusing and some are redundant. However, there are some subtle differences between the various acronyms, at least according to their most common usages. Following is our interpretation of this rather confusing array of terms, as of 2005.

Note, that after each term, I indicate the number of results that Google offers when searching for this term, as of March 2005. It is my belief that these numbers will migrate over time, indicating the trends both of verbiage, as well as the trends towards utilizing terms which indicate greater levels of interoperability. This position is similar to that taken by Naisbitt in his 1982 book Megatrends; namely that the frequency of printed usage of different terminology indicates important societal trends.

Following are a variety of terms which are frequently utilized to describe, with various intonations, the process of documenting information concerning the medical care of patients.

  • Document Management System – 65,000 Google search results
    (when adding +medical) in March 2005
    • A Document Management System implies the ability to manage the individual documents within an individual physicians office. It lacks, in general, the interconnectivity capabilities of both an EMR and an EHR.
      • An example would be a scanning system which can scan in previously produced documentation, whether that documentation be produced by handwriting, dictation, or some other means.
      • A second example would be a template driven document production system.
      • Voice Recognition software, including Dragon Medical®, when used alone, can be part of a document management system, and when utilized with PaperPort for filing can be another example of a document management system.
  • Automated Medical Record – 500 Google search results in March 2005
    • This term is obviously used only infrequently at present. However, it was an early stage of ‘automating’ the process of medical documentation.
    • “Information stored on a standard personal computer doesn’t comply with legal requirements for electronic medical records, so a paper file must be maintained. The computer information is used as a working file, and then pages are printed and filed in the chart.” http://www.aafp.org/fpr/july96/computer/records.html
  • EPR – Electronic Patient Record – 66,000 Google search results in March 2005
    • This is rather similar to Computerized Patient Record. It is an older term, and is remaining popular largely because of the Medical Records Institute, the entity which runs the TEPR, Towards an Electronic Patient Record, convention; TEPR is now in its 21st year.
  • CPR – Computerized Patient Record – 28,000 Google search results in March 2005
    • The CPR is defined as a computer-based record that includes all clinical and administrative information about a patient’s care throughout his or her lifetime. The documentation of any practitioner ever involved in a person’s healthcare would be included in the CPR, extending from prenatal to postmortem information. This is one of the original phrases for what was until recently called the EMR, but is now generally referred to as the EHR. (adopted from HIPAAdvisory.com – http://www.hipaadvisory.com/action/ehealth/EHR-reality.htm)
    • Interestingly, a current search of Google for Computerized Patient Record will result in dozens of articles from the mid to late 1990’s.
    • The VA program, continues to use this terminology, calling their VISTA system a CPRS or Computerized Patient Record System, as early as 1996. See: http://www1.va.gov/CPRSDEMO/
  • Computerized Medical Record – 10,000 Google search results in March 2005
    • This term is relatively infrequently used in this century. However, in the 1990’s it was more common.
    • “At this level, physicians and staff collect information on paper and scan it into the computer. As with the automated medical record, it’s departmentalized, so patients must provide their names and other information each time they visit a different department. However, the computerized medical record addresses some legal issues–such as preserving data integrity–because information can’t be altered on screen.” From the AAFP, 1996; http://www.aafp.org/fpr/july96/computer/records.html
  • CCR – Continuity of Care Record – 5,000 Google search results in March 2005
    • This is a standard of ‘interoperability’ which has recently become popularized. It is a “snapshot” of a patient’s care which can frequently be downloaded into a “Thumb Drive” or other very small portable memory storage device, and brought by a patient to various health care facilities. It frequently includes:
      • History of Present Illness
      • Current Medical Conditions
      • Past Medical History
      • Allergies
      • Medications
    • The EHR ideally would provide this function, however as true interoperability between EHR platforms is not likely in the foreseeable future, the CCR allows for selected information to be shared between providers. It uses neutral technology, so there is not need to purchase proprietary software to interpret the record. Waegemann, CPRI, 2004
  • PHR – Personal Health Record – 58,000 Google Search results in March 2005
    • The emphasis in the PHR is on the individual patient.
    • With a PHR, patients can frequently carry around a thumb drive or card holding digital data to their various physicians, having each physician add to the data. It is similar to the CCR standard, but is more patient centric, as opposed to physician centric. Some of these allow the patients to update their own information.
  • EMR – Electronic Medical Record – 225,000 Google search results in March 2005
    • This implies a level of sophistication above a “Document Management” system. Not only does an EMR allow for you to create documents within your office, it allows you to import information from a variety of external sources, such as:
      • Laboratories
      • Radiology facilities
      • Pharmacies
    • While there are precious few black and white distinctions regarding this nomenclature, an EMR will frequently have the ability to “upload” or transmit information to a pharmacy, specifically regarding individual prescriptions for an individual patient.
    • Definition “Electronic record with full interoperability within an enterprise (hospital, clinic, practice).” Peter Waegemann May 2003 – Healthcare Informatics
  • EHR – Electronic Health Record -109,000 Google search results in March 2005
    • This implies a sophisticated level of interoperability within the community. The implication of the “Health” as opposed to the “Medical” in EMR is that it is a longitudinal record of an individual patient’s health record.
      • The EHR is generally not considered ‘owned’ by any one physician, but rather is compiled, in many instances, from pieces of information which can be added by any / all of the following:
        • Family Physician – Primary Care Physician
        • Specialist(s)
        • Laboratory
        • Radiology facilities
        • Pharmacies
        • Insurance carriers
      • Each of the above entities is capable of both receiving information from and providing information to the longitudinal EHR. Obviously some entities will do more “uploading” and others will do more “downloading”. However, the bi-directional free interoperability of the EHR is its major distinguishing feature, differentiating it, in common parlance, from an EMR. It is also broader in context that the EMR, as it is the aggregate of the total experiences related to patient care, not just documentation of medical information.
        • HIMSS provides the following definition: “The Electronic Health Record (EHR) is a secure, real-time, point-of care, patient centric information resource for clinicians. The EHR aids clinicians’ decision making by providing access to patient health record information when they need it and incorporating evidence-based decision support. The EHR automates and streamlines the clinician’s workflow, ensuring all clinical information is communicated and ameliorates delays in response that result in delays or gaps in care. The EHR also supports the collection of data for uses other than clinical care, such as billing, quality management, outcomes reporting, and public health disease surveillance and reporting.” HIMSS 2002

It is my opinion that the relationship between the number of search results for EMR and EHR will reverse itself within the next 12 – 24 months, as more and more emphasis is being placed on the interoperability of the various programs.

Finally I am hesitant to offer costs of various levels of sophistication. However, having frequently been asked, here goes:

  • Many Document Management Systems will cost between $1000.00 and $5000.00. For instance, one could consider voice recognition software and a collection of MS Word macros a document management system.
  • Many Electronic Medical Records packages will cost around $10,000.00 per provider, inclusive of all associated installation and training costs.
  • Most Electronic Health Records packages will cost a medical group substantially over $10,000.00 per provider, and will probably cost between $25,000 and $50,000 per provider for a complete implementation.